Magnetic Resonance-Guided Focused Ultrasound

This policy covers Magnetic Resonance‑Guided Focused Ultrasound (MRgFUS) for palliation of metastatic bone pain in adults who have declined, failed, or are not candidates for radiotherapy, for medication‑refractory essential tremor and tremor‑dominant Parkinson disease, and for noninvasive uterine fibroid ablation as a uterine‑sparing option in selected women. Coverage is limited to these specified indications and device- and patient‑specific criteria (e.g., prior radiotherapy failure or candidacy, uterine size/fertility considerations), is subject to the member’s benefit plan/contract, and MRgFUS is investigational and not covered for other or unlisted indications.

"Pain palliation in adults with metastatic bone cancer who have declined, failed, or are not candidates for radiotherapy."

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